UnitedHealth Group

Clinical Solutions Pharmacist, Utilization Management - Remote

UnitedHealth Group$91K — $163K *
US-AnywhereRemote in Eden Prairie, MN
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • PharmD or BS in Pharmacy required
  • Current pharmacist license in good standing
  • Experience in Managed Care, PBM, health plan, or utilization management
  • Proficient in RxClaims configuration and claim adjudication logic
  • Background in clinical policy development or formulary management
  • Strong collaboration experience across clinical, operational, and technical teams
  • Ability to analyze complex issues and propose effective solutions
  • Solid written and verbal communication skills with Microsoft Office proficiency
  • Excellent organizational skills managing multiple priorities

Responsibilities

  • Lead clinical efforts for utilization management coding and claims adjudication strategies
  • Collaborate with cross-functional teams to optimize adjudication logic
  • Act as the clinical liaison to align strategies and outcomes across the organization
  • Evaluate medical literature and trends to inform drug coverage policies
  • Present utilization management criteria to key committees
  • Ensure high standards of clinical integrity and equitable medication access
  • Conduct in-depth evaluations to support utilization management programs

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase option
  • 401k contribution
  • Wide range of benefits and incentives available
Full Job Description


Primary Responsibilities:

  • Serve as the clinical lead for utilization management coding, claim adjudication strategy, and system configuration activities, translating clinical policy intent, formulary strategy, and P&T decisions into operational requirements, RxClaim coding specifications, business rules, and automated decision logic
  • Partner with technology, product, claims, coding, and operations teams to design, implement, test, and optimize adjudication logic, ensuring accurate execution of clinical programs, regulatory compliance, operational efficiency, and a seamless provider and member experience
  • Act as the primary clinical liaison between business, product, technology, and operational stakeholders, ensuring alignment between clinical strategy, system functionality, adjudication outcomes, and organizational objectives
  • Apply strong clinical knowledge of therapeutics and evidence-based medicine to evaluate medical literature, clinical guidelines, and healthcare trends, contributing to the development of drug coverage policies
  • Presentation of utilization management criteria to committees such as the National Pharmacy & Therapeutics (P&T) committee and Utilization Management Committee
  • Uphold high standards of clinical integrity and ethical practice to ensure fair and equitable access to medications through utilization management strategies
  • Apply advanced therapeutic expertise to evaluate medical literature, clinical practice guidelines, pipeline therapies, competitive intelligence, regulatory requirements, and market trends to support development and maintenance of utilization management programs and coverage criteria
  • Develop and present clinical analyses, recommendations, and utilization management strategies to Pharmacy & Therapeutics Committees, senior leadership, product teams, and other key stakeholders
  • Partner with Drug Intelligence, Pipeline, Industry Relations, Formulary Strategy, and Clinical Utilization Management teams to evaluate emerging therapies and develop innovative coverage and management strategies, ensuring the strategies are coded accurately


You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • PharmD or BS in Pharmacy
  • Current pharmacist license in good standing
  • Managed Care, PBM, health plan, or utilization management experience
  • Experience working with RxClaims configuration, claim adjudication logic, and/ or utilization management coding activities
  • Experience supporting clinical policy development, utilization management programs, or formulary management
  • Experience collaborating across clinical, operational, technical, and business teams
  • Demonstrated ability to analyze complex clinical and operational issues and develop practical solutions
  • Demonstrated solid written and verbal communication skills with proficiency in Microsoft Office applications
  • Demonstrated solid organizational skills with the ability to manage multiple priorities and competing deadlines


Preferred Qualifications:

  • Completion of an accredited pharmacy residency or other advanced clinical training
  • Residency training or other advanced clinical experience
  • Experience developing coverage policies for drug coverage programs
  • Experience participating in large-scale cross-functional projects involving product, technology, analytics, or operations teams
  • Experience supporting AI, automation, or digital transformation initiatives within healthcare or pharmacy benefit management environments


*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ

Similar Jobs

More Jobs at UnitedHealth Group

More Healthcare Jobs

Find similar Clinical Solutions Pharmacist, Utilization Management - Remote jobs: